Internal medicine: What other docs should know

“Internal medicine” (IM) comes from the German term Innere Medizin, meaning that early internal medicine doctors were trained to focus on and treat diseases that originated “from within” the body, utilizing laboratory diagnosis in addition to physical and clinical examination.

As an internal medicine resident practicing in Biloxi and Jackson, Mississippi, I have had the opportunity to work very closely with physicians of many different specialties, both on a primary and consult basis. Here are a few things I and my colleagues in internal medicine wish our friends in the other disciplines knew about what we do.

IM treats the whole patient

When you consult internal medicine, don’t expect to get back a one-paragraph consult note. Internal medicine doctors are legendary for their thoroughness and will look at every aspect of the patient.

We generally approach each case from a broad perspective that still somehow infuses an incredible amount of detail into every comorbidity and chronic disease and will incorporate detailed diagnostic schema with expansive differential diagnosis on each identified problem.

We aren’t happy with simply putting out fires; we like to address the root causes of disease. And as a consultant, if you get called by IM, you can be sure we have done the work-up.

IM is highly evidence based

Internal medicine physicians have a strong need to justify their decisions with mountains of data. That’s why evidence-based medicine (EBM) is so important to us!

IM doctors are some of the most likely in the hospital to reverse years of clinical practice on a single rigorous, well-written meta-analysis. Likewise, if you ever get into a friendly argument with an IM doc, know that a stack of recent, high-quality evidence dropped onto our desk will not only be welcomed, but will light up our eyes like the first snowfall of winter.

IM means complex cases, many comorbidities and absolutely no children

At my hospital and clinic, IM physicians’ patient rosters mostly consist of patients with several complex chronic diseases.

Also, we absolutely do not see pediatric patients. We will on occasion consult on pregnant women, but we tend to be quite wary of any medical management involving children.

What can you consult us for?

More like what can’t you consult us for? Am I right? (That would be neurosurgery, trauma, knee replacements and, as previously stated, anything involving children.)

But seriously, our bread and butter is the management of complex, chronic conditions such as diabetes, kidney disease, hypertension, hyperlipidemia, pulmonary disease and cardiovascular disease. We are also useful for evaluating patients for pre-surgical procedures. Just don’t consult us to “clear” a patient for a surgery because we don’t do that — we “risk stratify!”

IM isn’t just primary care

Finally, while IM physicians pride themselves on being the “quarterback” of the care team both inpatient and outpatient, it’s important to close by highlighting that what makes IM stand out more than anything else is how broad and diverse the specialty is.

IM boasts as many sub-specialties (and sub-sub-specialties) as there are organs in the body. They’re not all cerebral either — some fields within IM are as interventional and procedure-heavy as a surgical specialty. Think interventional cardiology, GI with advanced endoscopy and interventional pulmonology. The really neat thing is that no matter what we do, IM physicians are united by a common foundation and the language learned in internal medicine training.

Is it reasonable to assume this is significant or can it simply not be fully excluded?

Speaking of language, the following video is required viewing for anyone that might find themselves on medicine rounds (thanks to the always hilarious Dr. Glaucomflecken):

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